Current Psychiatry Reports

Christiansen, Dorte M.; Berke, Emma T.

doi: 10.1007/s11920-020-1140-ypmid: 32125541

Purpose of ReviewSex differences in PTSD are well-established with a 2:1 sex ratio favouring women. Less well-established is the basis of such differences. The purpose of this review is to explore recent research examining potential gender- and sex-based contributors to sex differences in PTSD.Recent FindingsWe identified 19 studies published since 2015. Masculinity is inconclusively associated with PTSD, but masculine ideals and masculine gender role stress are positively associated with PTSD. Among the sex-related factors, testosterone, oestradiol, progesterone, and ALLO/5α-progesterone ratio are believed to be involved in the development of PTSD. These factors likely affect PTSD risk directly and through epigenetic mechanisms.SummaryFindings suggest that gender and sex have multiple ways of affecting PTSD, including gender roles, genetic predisposition, and hormonal influences. These factors work together to put women at a particular risk of developing PTSD. By conducting more research, we may improve prediction, prevention, and treatment of PTSD.

Szentágotai-Tătar, Aurora; Nechita, Diana-Mirela; Miu, Andrei C.

doi: 10.1007/s11920-020-1142-9pmid: 32076847

Purpose of ReviewStudies on the relations between shame and anxiety and obsessive-compulsive and related disorders (OCRDs) are reviewed, with a focus on recent work.Recent FindingsMedium-sized positive correlations have been consistently found across anxiety disorders and OCRDs, suggesting that this relation is transdiagnostic. Most studies focused on shame-proneness and found similar relations across multiple types (e.g. internal, external) and domains (e.g. bodily, characterological, behavioural) of shame, with little variation between clinical and non-clinical populations and different age categories. However, most studies are cross-sectional and correlational and by separately studying clinical and non-clinical populations, they do not give a unitary dimensional view of the relation between shame and symptoms. Emerging findings suggest that shame may be a marker of the response to treatment in these disorders, and its relation with symptoms may be bidirectional.SummaryThe consistent but medium-sized associations between shame and symptoms of anxiety and OCRDs warrant the future search for mediators and moderators.

Gill, Nav; Bayes, Adam; Parker, Gordon

doi: 10.1007/s11920-020-01143-6pmid: 32215771

Purpose of ReviewThe nosology and management of antidepressant-associated hypomania (AAH) in the treatment of unipolar depression requires clarification. We sought to review recent studies examining AAH, focusing on risk factors, differing explanatory models, and management strategies.Recent FindingsAAH occurs more frequently in those of female gender, younger age, and with a bipolar disorder (BP) family history. Depressive features (e.g., suicidal ideation, psychotic symptoms) in those with AAH were similar to those with established BPs. Explanatory models for AAH describe it as (i) a transient iatrogenic event, (ii) a specific “bipolar III” disorder, (iii) indicative of “conversion” to BP, (iv) acceleration of BP, and (v) coincidental and unrelated to antidepressant medication. Management recommendations include antidepressant cessation, atypical antipsychotic medications, or switching to a mood stabilizer.SummaryDeterminants and management of AAH in the treatment of unipolar depression requires considerable clarification, likely to be achieved by close clinical review and refined research studies.

Strachan, Laura P.; Hyett, Matthew P.; McEvoy, Peter M.

doi: 10.1007/s11920-020-1139-4pmid: 32076845

Purpose of ReviewThis review describes imagery rescripting (ImRs) and its clinical application to anxiety disorders and obsessive-compulsive disorder (OCD). Variations in ImRs delivery, clinical evidence, and theories of potential mechanisms of change are also reviewed. Finally, we propose a future research agenda.Recent FindingsThere is some evidence that ImRs affects memory processes and schemas. ImRs is associated with reductions in cognitive-affective, physiological and behavioural symptoms of social anxiety disorder and reductions in OCD-related distress and OCD symptoms. ImRs for other anxiety disorders has not been evaluated.SummaryWhile ImRs appears to be an effective intervention for social anxiety disorder and OCD, more research is needed to (a) systematically compare ImRs to established interventions, (b) evaluate ImRs for other anxiety disorders, (c) test theorized mechanisms of change, and (d) evaluate the impact of moderating factors and treatment variations on therapeutic outcomes.

Grimm, Oliver; Kranz, Thorsten M.; Reif, Andreas

doi: 10.1007/s11920-020-1141-xpmid: 32108282

Purpose of ReviewAttention deficit hyperactivity disorder (ADHD) shows high heritability in formal genetic studies. In our review article, we provide an overview on common and rare genetic risk variants for ADHD and their link to clinical practice.Recent findingsThe formal heritability of ADHD is about 80% and therefore higher than most other psychiatric diseases. However, recent studies estimate the proportion of heritability based on singlenucleotide variants (SNPs) at 22%. It is a matter of debate which genetic mechanisms explain this huge difference. While frequent variants in first mega-analyses of genome-wideassociation study data containing several thousand patients give the first genome-wide results, explaining only little variance, the methodologically more difficult analyses of rare variants are still in their infancy. Some rare genetic syndromes show higher prevalence for ADHD indicating a potential role for a small number of patients. In contrast, polygenic risk scores (PRS) could potentially be applied to every patient. We give an overview how PRS explain different behavioral phenotypes in ADHD and how they could be used for diagnosis and therapy prediction.SummaryKnowledge about a patient’s genetic makeup is not yet mandatory for ADHD therapy or diagnosis. PRS however have been introduced successfully in other areas of clinical medicine, and their application in psychiatry will begin within the next years. In order to ensure competent advice for patients, knowledge of the current state of research is useful forpsychiatrists.